Why It’s So Tough to Reduce Unnecessary Medical Care
Treatments that don’t help patients, and may even harm them, are difficult to eliminate because they can be big sources of revenue.
Insurance
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New California Law Offers Fresh Protection From Steep Ambulance Bills
The law, which takes effect Jan. 1, prohibits out-of-network ground ambulance operators from billing patients more than they would pay for in-network rides. It also caps how much the uninsured must pay.
For ACA Plans, It’s Time to Shop Around
Episode 321It’s Obamacare open enrollment season, which means that, for people who rely on these plans for coverage, it’s time to shop around. With enhanced premium subsidies and cost-sharing assistance, consumers may find savings by switching plans. It is especially important for people who lost their coverage because of the Medicaid unwinding to investigate their options. Many qualify for assistance. Meanwhile, the countdown to Election Day is on, and Ohio’s State Issue 1 is grabbing headlines. The closely watched ballot initiative has become a testing ground for abortion-related messaging, which has been rife with misinformation. This week’s panelists are Mary Agnes Carey of KFF Health News, Jessie Hellmann of CQ Roll Call, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Rachana Pradhan of KFF Health News.
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‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States
As Medicaid programs across the nation review enrollees' status in the wake of the pandemic, patients struggle to navigate the upheaval.
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Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans
More than 16 million Americans who buy their own health insurance through state and federal marketplaces have until Jan. 15 to compare prices, change their coverage, or enroll for the first time.
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Smaller Employers Weigh a Big-Company Fix for Scarce Primary Care: Their Own Clinics
Company health clinics are most common at large workplaces, but some small employers say they see advantages, too: healthier workers, lower costs, and better access to primary care.
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Quick Genetic Test Offers Hope for Sick, Undiagnosed Kids. But Few Insurers Offer to Pay.
A new, rapid genetic test shows promise in increasing diagnoses and improving treatment for some children with rare genetic conditions. Many insurers won’t cover it, but Florida's Medicaid program is among those that see benefits — and, potentially, savings.
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Tiny, Rural Hospitals Feel the Pinch as Medicare Advantage Plans Grow
More than half of seniors are enrolled in private Medicare Advantage plans instead of traditional Medicare. Rural enrollment has increased fourfold and many small-town hospitals say that threatens their viability.
The Open Enrollment Mixing Bowl
Episode 319Open enrollment for Medicare beneficiaries with private health plans began Oct. 15, to be followed Nov. 1 by open enrollment for Affordable Care Act plans. The selection for both is large — often too large to be navigated easily alone. And people who choose incorrectly can end up with unaffordable medical bills. Meanwhile, those on both sides of the abortion issue are looking to Ohio’s November ballot measure on abortion to see whether anti-abortion forces can break their losing streak in statewide ballot questions since the overturn of Roe v. Wade in 2022.
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Abortion Coverage Is Limited or Unavailable at a Quarter of Large Workplaces
A KFF survey of employer health benefits shows that 28% of large U.S. companies have limited or no access to abortion under company health insurance.
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Medicare Enrollees Can Switch Coverage Now. Here’s What’s New and What to Consider.
Fall is the time when enrollees in the federal program for older people and people with certain disabilities can make changes to their health and drug plans. The decision can be complicated, but here are some key points to keep in mind.
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Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients
Software sifts through millions of medical records to match patients with similar diagnoses and characteristics and then predicts what kind of care an individual will need and for how long. New federal rules will ensure human experts are part of the process.
By Susan Jaffe -
She Received Chemo in Two States. Why Did It Cost So Much More in Alaska?
A breast cancer patient who received similar treatments in two states saw significant differences in cost, illuminating how care in remote areas can come with a stiffer price tag.
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GOP Presidential Primary Debate No. 2: An Angry Rematch and the Same Notable No-Show
Though never framed as a marquee issue, the topic of health care crept into the chaotic seven-way faceoff throughout the evening, highlighting Republican culture-war themes.
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Readers Rail at Social Security Overpayments and Insurers’ Prior Authorizations
KFF Health News gives readers a chance to comment on a recent batch of stories.
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New Medicare Advantage Plans Tailor Offerings to Asian Americans, Latinos, and LGBTQ+
As more seniors opt for Medicare Advantage, a few small insurers have begun offering plans that provide culturally targeted benefits for cohorts including Asian Americans, Latinos, and LGBTQ+ people. The approach, policy researchers say, has potential and perils.
More Medicaid Messiness
Episode 316At least 30 states are reinstating coverage for children wrongly removed from the rolls under Medicaid redetermination, the federal government reported. It’s just the latest hiccup in the massive effort to review the eligibility of Medicaid beneficiaries now that the program’s pandemic-era expansion has expired. And federal oversight of the so-called unwinding would be further complicated by an impending government shutdown. Rachel Roubein of The Washington Post, Sandhya Raman of CQ Roll Call, and Sarah Karlin-Smith of Pink Sheet join KFF Health News chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KFF Health News’ Samantha Liss, who reported and wrote the latest KFF Health News-NPR “Bill of the Month” feature, about a hospital bill that followed a deceased patient’s family for more than a year.
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What Happens to Health Programs if the Federal Government Shuts Down?
Medicare and Medicaid shouldn’t be affected, but confusion can be expected.
By Julie Rovner -
How Will Rural Americans Fare During Medicaid Unwinding? Experts Fear They’re on Their Own
As states review their Medicaid rolls after the expiration of a pandemic-era prohibition against kicking recipients off the government insurance program, experts say the lack of help available to rural Americans in navigating insurance options puts them at greater risk of losing health coverage than people in metropolitan areas.
Underinsured Is the New Uninsured
Episode 314The percentage of working-age adults with health insurance went up and the uninsured rate dropped last year, the U.S. Census Bureau reported this week. There isn’t much suspense about which way the uninsured rate is now trending, as states continue efforts to strip ineligible beneficiaries from their Medicaid rolls. But is the focus on the uninsured obscuring the struggles of the underinsured? Margot Sanger-Katz of The New York Times, Sarah Karlin-Smith of the Pink Sheet, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico join KFF Health News’ Emmarie Huetteman to discuss these issues and more.